Self Learning Assessment 2005 (March 01, 2005)

The SLSA program is based on current, referenced literature and consists of 40 questions, answers, rationales and references. Answers appear at the end of each quiz.

Dentists who complete the 15 question quiz in the November, 2005 issue of Oral Health may be eligible to receive continuing education points. The names and license numbers of all who complete the quiz will be forwarded to their respective provincial licensing authorities.


After initial placement of a removable partial denture (RPD), which of the following would you expect to see?

1. Increased plaque accumulation on teeth in contact with the RPD.

2. A change in the microbial content of the plaque.

3. Initial increased mobility of abutment teeth.

4. Deterioration of the periodontal status of the remaining teeth.

A. 1, 2, 3D. 4 only

B. 1 and 3E. All of the above

C. 2 and 4


Initial periodontal screening of a patient requiring an RPD must assess the general status of the periodontium for long-term prognosis. Oral hygiene, plaque presence, any gingival inflammation, osseous support of remaining teeth and mobility all need examination and recording.

Several studies have shown that plaque formation is enhanced on teeth in contact with an RPD and that patients require instruction on specific methods of oral hygiene of these endangered teeth. Additionally, there is a proliferation of spirochete bacteria at the expense of cocci and short rods-thereby altering the plaque composition.

It would appear that clasp-retained RPDs produce less torque on abutment teeth than intracoronal attachment designs. In both cases, however, there is a “settling in” period of 1-1 1/2 months during which there is an increased mobility of abutment teeth, which later stabilize.

In two groups of patients with moderate to advanced periodontal bone loss, evaluation of health status was made over a five-year period. One group had fixed cantilevered distal extension bridges. The other had treatment with RPDs. Both treatment groups showed no progression of periodontitis.

Thus, properly designed and maintained RPDs will give long-term service without deterioration of the periodontium, provided pre-prosthetic periodontal health is established and maintained with meticulous oral hygiene.


Petridis, H., and Hempton, T.J. Periodontal considerations in removable partial denture treatment: A review of the literature. Int J Prosthodont. 14:164-172. 2001.


Fluoride varnish is as effective as acidulated phosphate fluoride (APF) gel in caries reduction.

Fluoride varnish is effective in reducing enamel caries incidence.

A. The first statement is true, the second is false.

B. The first statement is false, the second is true.

C. Both statements are true.

D. Both statements are false.


Fluoride varnish has been shown to be at least as effective, if not more so, than APF gels and fluoride varnishes present several important clinical and practical features compared to APF gels:

– Varnishes are quick and easy to apply (usually one minute vs. four minutes for gels).

– Varnishes do not have the bitter taste of APF gels and can be readily applied in more difficult cases, such as young children or the handicapped.

– With varnishes, the amount of fluoride ingested is small. Plasma levels of fluoride barely change after application, but can increase significantly after APF gel application.

While certain adverse reactions-notably allergic-have been attributed to fluoride varnish use, the only real disadvantage is a yellowish-brown discolouration of the teeth that disappears after a day or so. Fluoride varnishes may be considered as part of any prevention-based strategy, regardless of the age of the patient. Promising results have also been reported for the efficacy of fluoride varnish in preventing root caries in the elderly. Other studies have shown that rinsing for 60 seconds twice daily with a mouthrinse containing 100 parts per million fluoride with or without essential oils is effective in promoting enamel remineralization and fluoride uptake.


1.Autio-Gold, J.T., Courts, F. Assessing the effect of fluoride varnish on early enamel carious lesions in the primary dentition. JADA 132:1247-1253, 2001.

2.Zero, D.T., Zhang, J.Z., Harper, D.S., et al. The remineralizing effect of an essential oil fluoride mouthrinse in an intraoral caries test. JADA 135:231-237, 2004.

3.Oral Care Report. Chester W. Douglass, Editor. Vol. 12, No. 3. 2003.


Salivary gland hypofunction

1. increases the risk of dental caries.

2. may be caused by medication.

3. can result in xerostomia.

4. is a condition of aging.

A. 1, 2, 3D. 4 only

B. 1 and 3E. All of the above

C. 2 and 4


Saliva is essential for oral and general health. Many medical conditions (Sjgren’s, diabetes, HIV infection) as well as medications can induce salivary gland hypofunction. Aging per se has no significant effect on salivary secretion. However, in the elderly, a common cause of salivary hypofunction relates to medications being taken for cardiovascular problems as well as anti-depressants, sedatives, anti-allergy medicaments and others.

Xerostomia and salivary gland hypofunction are not always present together. Dental caries and also oral fungal infections are common complications associated with these conditions. The quality of life of the individual is greatly affected, such as a dry mouth, difficulty in eating, speaking, swallowing and chewing. The wearing of oral prostheses is complicated. Taste is affected and soft tissues (lips and tongue) may become cracked and painful.

Management of this condition should include daily oral hygiene, frequent professional oral evaluation and care, hydration, lubrication, stimulation of salivary glands with sialogogues, nutritional counselling and avoidance of irritants such as alcohol and tobacco.


1.Navazesh, M. How can oral health care providers determine if patients have dry mouth? JADA. 134:613-618. 2003.

2.Xerostomia. ADA Council on Scientific Affairs. JADA. 134:619-620. 2003.


Missing gingival papillae at the front of the mouth are unsightly. Which of the following can cause the problem?

1. Acute gingivitis.

2. Advanced periodontal disease.

3. Orthodontic treatment.

4. Age.

A. 1, 2, 3D. 4 only

B. 1 and 3E. All of the above

C. 2 and 4


Acute gingivitis of the ulcerative type can cause loss of the interdental papillae, but the condition is not very common. In advanced periodontal disease, there is loss or cratering of the interdental alveolar bone crest. The decreased support of the gingival papillae causes a space to develop and these spaces are referred to as “black holes.” Missing papillae can also result from orthodontic treatment in which an over-divergence of the roots of the teeth can occur from poor placement of brackets. Age is not considered a factor in the etiology.

Aesthetic treatment of the condition is several fold dependent upon severity. Enameloplasty by strip removal of 0.5-0.75mm of the adjacent teeth is often sufficient. The teeth can then move together of their own accord or orthodontic movement may be considered. Controlled crown lengthening can be used to carry the papilla into a new position to improve aesthetics. Another approach is to partially fill the space with a direct bonding resin, giving the illusion of a higher papilla.

A recent method involves papillary reconstruction by means of periodontal plastic surgery. A subepithelial connective tissue graft is carried into position from an incision at the muccogingival junction.


1.Keim, R.G. Aesthetics in clinical orthodontic-periodontic interactions. Periodontology 2000.
27:59-71. 2001.

2.Reddy, M.S. Achieving gingival esthetics. JADA. 134:295-304. 2003.

Answers to the February 2005 SLSA Quiz

5. E

6. A

7. A

8. C